Endoscopic Management and Role of Interim Plastic
Biliary Stenting in Large and Multiple Pigmented
Common Bile Duct Stone
Arunkumar Krishnan, Ravi Ramakrishnan
Citation Information :
Krishnan A, Ramakrishnan R. Endoscopic Management and Role of Interim Plastic Biliary Stenting in Large and Multiple Pigmented Common Bile Duct Stone. Euroasian J Hepatogastroenterol 2013; 3 (2):89-93.
Background/Aim: Different endoscopic modalities are available
for the extraction of common bile duct (CBD) stones. However,
there is no clear consensus on the better therapeutic approach.
Aim of the study was to analyze the effectiveness of endoscopic
retrograde cholangiopancreatogram (ERCP) and endoscopic
sphincterotomy (ES) and the role of ‘interim’ plastic biliary stent
deployment in difficult pigmented CBD stones.
Materials and methods: One hundred and sixty-three patients
with CBD stone who underwent ERCP and ES between May
2006 and August 2010 were included in the study. Patients
with incomplete clearance of stone underwent an ‘interim’
10 cm 7 Fr size plastic stent. Approximately 3 weeks later, stone
removal was attempted.
Results: ERCP and ES with stone clearance were successful
in 114 (69.9%) patients. The mean size of the stone was 1.5 cm
(p < 0.0001). In 21.5% patients in whom ERCP and ES was
not successful, stone retrieval was possible after plastic stent
deployment after a median of 24 days. The median number and
size of stones per patient was significantly reduced after biliary
stenting compared with before [5 (3) vs 2 (1) (p < 0.0001)], [2.8
(1.5) vs 2 (1) (p < 0.001)], respectively.
Conclusion: Plastic biliary stenting for difficult common bile
stones becoming decrease in stone sizes. Unlike cholesterol
stones, stent placement of 3 weeks was related with large and/or
multiple stones becoming decrease in size and/or disappearing
without unplanned events in pigment stones.
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